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HomeMy WebLinkAbout0549 BAY LANE - Health S�Iq RAY LooQ CBAttrv;it l87 - 053 E MEAD® KEEPING YOU ORGANIZED No. 12534 2-153LOR Os mW U, FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10°k CeropedFnersoureinp POST-CONSUMER wvw.sa°oizco°rem'ro MADE W USA WORGANIZEDATSmEA MM os LOCATION SEWAGE PERMIT NO• 78 - 67 VILLAGE I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER i DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i yi �- �; �7 yy ,y 3� �, � � � Mash .�+o�S � _ f No......0 7 YmB ................. THE COMMONWEALTH OF MASSACHUSETTS BOAR'Q, OF HEALTH w...!✓A.. ..-..'....................OF.. �9.ti.A!.�.TA�_.f .-------------•---......._....................... Apptiration for Dispoii al Workti Tomitrurtion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ).an Individual Sewage Disposal System at: 9— Location-Address or Lot No. Owner Address Instal) r Address UType of Building Size Lot.t�j..Z��_.._._._Sq. feet Dwelling—No. of Bedrooms..............:.............................Expansion Attic ( ) Garbage Grinder '-� Other—Type of Building J p� yp g __�) ............. No. of persons..._._.- ......_...__..... Showers ( ) — Cafeteria ( ) a Other fixtures ........................................ ------------------------------- ..... W Design Flow..............V1.6.......... .._ __gallons per person per day. Total daily flow.............. ................gallons. WSeptic Tank—Liquid'capacity .� allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No......... ..... Width�..�.............. Total Lenith.................... Total leaching area_..._. ._.__........sq. ft. 3 Seepage Pit No._._..Z.._._I... Diameter....... .......:.. Depth below inlet....6.......t.. Total leaching area.....40 �..sq. ft. Z Other Distribution box ! Dosingtank ( ) aPercolation Test Results//// 11 erformed b j ✓. L _----------------- Date..7: 1--19 f 14 Test Pit No. 142e....minutes per inch Depth of Test Pit.....................Depth to ground water----c1U:e,'!r,�`L Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ E _ f -- ; _*/_ ® Description of Soil----•- - - ------ ------- -0 >�a?:-..... . = - 2 1--. .... - * . U -----•-•-•----------•------••••--------•--...._..................•--•-•-------------.......-•-•-•--•-••--------•---•--••••-•••--------•-•--------...-••--------•--------.....---------.........---------- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... --- ------------•--•--•---•••••-•---••••--••--•••.._._._.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI ME 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign d. Date Application Approved By..... �j'' ........................ ..--- Date Application Disapproved for the following reasons----------------------------------------------------------------------------'..--------------------------••-••--- ........--•---------------•------•----.............----------...------...-------•--...-•---•------............------------......----------------...----------------------------------------------------- A Date PermitNo......................................................... Issued... . •--•-------�-�-.7�....------. Date ��t t.t 6 se.Pt�c -rAWV. 44C) tISU '�+ • LEA � ' 31aF.aa/ALL. AE&A =-t� 6o-rrOAn Alta A- a O{a �.F 1 o o G P A n too sip X, 1 CAF -� t TOT<► T�Est 6 N E3 sr> G�'D i' PEZC.o t_.io.T 10►..! P.,dTL t, I W 2 IW 1J OQ.L�5. � ' 1 zsv coo- • box • -� . M _, � tom✓ t.�'AC! '� � � . y ` 1,A 54 A Kuv4AL •9�,DGs St�SlJtL VKT ` Q(o•�i . Ss�PfIG `` 6 TAUS. ` WOO &,© luv. A- PI T WAfpsAgD r CV---2 T 1 F 1 a a PLc>T Pt_.A W Ow W AT'62., PL-a I" t r-rrT{F`f T"AT -r"* t4E2.E.o►4 COAAP4-Y5 WtTH TI-►Cz tolUE.1..�,-tom. �---.4T��GG� Ar•lb S�TF3ACV R6C?W M6t.lTsj OF T1-IE. � (. 11C DATE. e A.X T'e 2 1C. t-►`�6 1�C. Q.jrr� tSTrm IZET> iLAIJn 2tJ�E`(Oe�, TW4 Pt-&W IA, tAO'r BASED O V AU U.KTeOMEuT OSTE.ZvI i , f-- MA.SS guz%-/Mf 4 T"Ga OFFSET; 54OUL'b uOT 3E USEt:> APPLACAWT To -pexee tswL 1.oT ' t_IIJE;. No. Fps.... _ .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH li!^ ........................OF.;.... �A4N...S.t{A 1�---------•--------•...... ....-....... . Apli iration for Uiipsal Marks Tonstrar#'tun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,, $ ........ i -tRt_�.. = ....- - .....L..........•--. R•---•----•--••---.....------..... --........ Location t o Address j . 1 . _ xd_• t _ ........................................... Y•4 /•s� sa`�......- .N .---.---1�?1t.i�C4:k?m f ; l Owner Address ------------------- Instal er Address Type of Building Size Lot.3z,,.kP..Q__.........Sq. feet Dwelling—No. of Bedrooms........................ .................Expansion Attic ( ) Garbage Grinder a`4 e of Buildin Other—Type g . ..._,�______________ No. of persons....... ____.._._.... Showers (, ) — Cafeteria d Other fixtures ..---•----------•--------------•-•---------•--------.......-------•----•-•---•. ..... -•------- W Design Flow.............IVIO........ }}j, �......gallons per person per day. Total daily flow----_......... -° . .........._gallons... ,,*-, W Septic Tank—Liquid capacit}�i�• Ogallons Length................ Width................ Diameter..._- . Depth th... "' --- x Disposal Trench—No......... .......... Width_.. .............. Total Length............,------ Total leaching area cc?_.._."._...+sq. ft. Seepage Pit No...... ......... Diameter.._...$_......... Depth below inlet.....4 ........... Total leaching area-. X_)..sq. ft. z Other Distribution box ( Dosin tank ( ) Percolation Test Results Performed b _. .. 3.3,� ....................... Date.. .°'. __ _____.._......►� Y �� r Test Pit No. 14. t.....minutes per inch Depth of Test Pit.................... Depth to ground,,water...n:1,j:' r Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil.... l� f= = " = ._. i r;� U -------------- -------------- •-------------- •------------------•----------------.-.-........ ......--------------------•-- ---------- •--------- .-.•••-•-••••------.....---••------------- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------- ------------------------ •............. •......- ----------- ..------------------------------------ •----------------------------------- •-------•-----•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT:., 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.............. .... ------------........------ Date Application Approved BY `...`.. ... •--------- = G 7i ' - Date Application Disapproved for the following reasons:............................................................................................................... .................•---------------...-----.....--------------•---........---------•--------...------••----------•----------•-----•---------••----------------•--------•-------•--------•---------•••----- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH ....... ....1!�:1..-l........OF........... Af/ ............................................. Trdifiratr of Tuntpffitnrr THLV'I,,� TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b •:44, x l �� ---------- -- ---- .:..... all Inster ;/ /,- 7 /v / at....... :. :'.. �` kf.� 1...._ r has been installed in accordance with the provisions of TIT LEE' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.� �... ..7 ............. da.ted__-.,��i ...................... .., � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH b .1.1v, /�✓':J.......:OF. � )GvL'Y1. .............. �._ N ....... . .... FEE.... ......... �iu�ruuttl rk� �un��riun rrmi� Permission is hereby granted..---,.. �'� �1�•L�'�=............................................ ..................... ....................... to Constrpct ( .4,or/Repair ( )'.an Individual Sewage Disposal Syst ti at No..y '` I::--•-�` ` ` �..:.:r. e,Y 00 4'-,---- -�,r `�(/ ................... Street as shown on the application for Disposal Works Construction Permit N�o......1........... Dated..�_�_.:_� ._... r: ------------- DATE.... Board b`f fI alth FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS I